Panic attacks. The light born at sunrise.
Panic attacks usually mean attacks of unreasonable strong fear and anxiety, accompanied by a number of symptoms, such as a feeling of irreality of what is happening around, dying, disappearance, fear of insanity, as well as loss of control over one’s body, disorientation in time and space and certain frightening bodily manifestations, which can manifest quite individually, for example, a strong heartbeat, dizziness, blurred vision, intense tension and the inability to relax, muscle cramps, trembling or seizures of arms and legs, feeling lack of air, inability to breathe or swallow, sweating, disorders of the digestive system and others. Each person who has experienced a panic attack for the first time begins to feel dread at the thought of the recurrence of such symptoms, which often leads to the panic disorder, a protracted period of attacks, accompanied by a fear of recurrence between them and the search for the causes of bodily symptoms by going to medical facilities and various doctors, but due to the absence and refutation of physiological diagnoses, thereby forming their own hypochondria, which exacerbates the problem even more. Experience has shown that the reasons for panic attacks are gradually discovered in the process of psychotherapeutic work, and I will for sure write about them, but client’s premature knowledge about them is not likely to solve the problem due to the lack of living through the new experience of arousal (in the general sense of the word) locked in the body as well as the impossibility of building a new psychological support in the changed circumstances independently, since when the client who suffers from panic disorder focuses on the figure (too strong a fear), it makes it impossible to reveal the background, which the therapist has to metaphorically become for some time, until the client will not assign this background for himself.
Often, people suffer from panic disorders for several years, undergo all medical tests (why our doctors do not tell patients about panic attacks, and continue to redirect to each other and treat vegetative-vascular dystonia, in rare cases, using the placebo effect, but more often aggravating the disorder with the additional development of hypochondria is a separate topic for conversation), but remain without diagnosis and help. The experience of having a panic attack is impossible to describe in words, and if the surrounding people (family and friends), as well as therapists themselves have never had such conditions, clients almost always feel very lonely due to the inability of others to share, understand and deeply sympathize, which makes the therapy process much more difficult due to the need for a longer time to build in the interpersonal client-therapist relationships of basic trust and create a safe environment.
During panic attacks there is usually a kind of distortion of the perception of time and space, 10 minutes may seem like hours, location is unreal and very distant, and the body seems an alien space. And if we recall the Einstein’s theory of relativity, which says that gravity is not the force of interaction of bodies and fields located in spacetime, but rather the curvature of spacetime, which is associated with the distribution of mass/energy, then it came to me that the deformed perception of space and time at the time of a panic attack makes a person become insensitive to gravity, i.e. makes him lose his sense of belonging, which means support, and so it turns out that the reason for this condition is the presence of mass/energy, in the language of Gestalt therapy, the presence of intense arousal in the body, to which we will get back later.
And now we shall proceed to how to help a client suffering from panic attacks learn to cope with attacks when he is alone, and since the main principle in Gestalt therapy is the principle of “here and now”, it will be relevant to ask at what time this happened and how long the attack lasted, as well as ask to describe where the client was and what objects surrounded him, and also what he relied on at the end when he coped with the panic. Even those, at first glance, trivial answers about time, 10 minutes, a room and some positive thoughts at the exit can give a person a sense of support the next time, even though these are only one way to overcome the condition.
There is also the theory of “oikos” and “polis”, which largely explains the causes of a panic attack. Gianni Francesetti psychiatrist, Gestalt therapist, author of the book “Panic attacks”, with whom I had the opportunity to work on this topic personally at a seminar organized by the Interregional Institute of Gestalt therapy and art in Dnipro, calls this phenomenon the way out of “oikos” (house, place for one) into “polis” (world, city, place for many). This transitional stage in the life of many people is accompanied by a need for safety while at risk, when old supports are lost, new living conditions are created, but new supports have not yet been formed, and a person cannot rely on the old ones for certain reasons, so the excitement that grows with the appearence of new needs, cannot be directed into actions and implemented.
The conflict between risk and security blocks creative adaptation as the means to find the best way to satisfy needs, the background collapses, the figure does not form, but the illusion of a fake figure appears under the guise of a need for security as a way of overcoming panic attacks, which is why working with the figure in this context not recommended, first you need to restore the background.
* Figure-background – a pair of terms used to describe the perceptual relationship between the focus object (figure) and the rest of the perceptual field (background). The figure usually has a shape or structure and protrudes forward from the background. The background looks relatively uniform and as if pushed back behind the figure. This connection in many cases can be two-way, if you focus your attention primarily on the background and not on the figure. The best way to understand the concept of a figure-background relationship is to understand that the outline or boundary that separates the figure from the background physically belongs to both of them, but perceptually belongs only to the figure. Consequently, the figure is endowed with form and shape, and the background remains obscure and shapeless.
Due to focusing on such a figure, a person suffering from panic attacks has the impression of running in a vicious circle, when all the passion is directed only at trying to solve the problem, by boosting the feeling of excitement and thereby creating a tunnel vision, i.e. dependent situation. It is for this reason that panic disorders affect mainly people who are prone to dependent behavioral tendencies. This kind of fixation on finding the cause (fake figure) we call not just panic attacks, but an aggravated condition – panic disorder.
Walter Benjamin, a German philosopher, cultural theorist and literary critic, describes two types of human sight: near and far. This concept is related to the structure of our eyes, although it was developed by art critics while exploring the perception of fine art as the study of the imaginative capabilities of the eye. Using these studies, we can describe the work of the therapist with the client’s figure as near vision, and with the background – as far. It is curious how the above mentioned tendencies in behavior and their relationship with the concepts of figure-background correlate with the vision of a person suffering from panic disorder. He is afraid of the feeling of blurred vision when it becomes background, and wanting to control everything, he feels the desire to embrace the maximum of figures with focusing power, which indicates the absence of supports in the background. In this case, the therapist can offer the client to focus on several items in the room, tell how he sees them and describe them. Often, such clients do an excellent job, and it is surprising for them that when they really need to concentrate and see something, they can do it easily.
But, nevertheless, some work with the figure needs to be practiced not in order to push the client into a “polis” (the world) and force awareness of his needs, turning bodily discomfort due to arousal into the action, but in order to develop reliance on their own desires and ability to connect with their own symptoms, and so that these symptoms would not seem so frightening, and own body – a hostile and alien space, so very important while working with panic attacks is the client’s acceptance of his body, the sensations arising in it, not as a terrible frightening elements, but as a joyful meeting with his own feelings, desires and needs. Therefore, it is appropriate at this point to talk about the theory of Self and its functions.
* Self is a process specific to each person, which characterizes his own way of reacting at this very moment and in this field in accordance with his personal “style”. Self is not just a person’s “being” but his “being-in-the-world”, which changes depending on the situations that arise.
In Gestalt therapy, self functions in three modes: as “id”, as “ego” and as “personality”.
- The function of “id” is connected with internal impulses, vital needs and, in particular, with their bodily manifestation. So, the “id” function indicates to me that I am hungry, depressed or relaxed, the”id” function manifests itself in my automatic actions: when I breathe, walk and even drive while thinking about something else. My “id” kind of guides me almost without my knowledge.
- The “ego” function, as opposed to “id”, is an active function of choice or conscious refusal: I myself, with full responsibility for my own actions, limit or expand contact with the environment around me, based on the awareness of my own needs and desires. Possible violations of this function are expressed, according to Goodman, in various “types of loss of the ego function”, which some authors consider as ego protection mechanisms or ego avoidance mechanisms and for their identification many Gestalt specialists, starting with the Polsters, use the double name – mechanisms of “resistance-adaptation”.
- The function of “personality” is the subject’s representations of himself, his own self-image, which allows him to acknowledge his responsibility for what he feels and for what he does. It is the “personality” function of my self that determines how I integrate my previous experiences, how I absorb what is happening to me in life, and it forms my sense of who I am.
This work with the functions of “id” and “personality” makes it possible to rely on the background. Therefore, while working with people suffering from panic attacks, it makes sense to ask the question “What are you at that time?” as it helps to awaken a person’s curiosity about himself, a kind of curiosity, which gives energy to get to know yourself in the process of life. After all, the fear of disappearing during a panic attack is nothing but a sign of distortion of the personality function. On such occasions I often remember when Lewis Carroll’s Alice was wondering what she would be like when she would disappeared, like a flame after a candle goes out. She also said: “Who am I then? Tell me that first, and then, if I like being that person, I’ll come up: if not, I’ll stay down here till I’m somebody else” – in my opinion, this is a very successful example of a therapist’s goal – to help clients to get to know themselves to be able to rely on the background, as during the transition from “oikos” to “polis”, as well as during any other changes in life.
Regardless of the basic mechanisms of contact interruption inherent in people suffering from panic attacks due to the feelings of fear of death, disappearance or insanity, accompanied by strong incomprehensible bodily symptoms, one can observe an excessive tendency to control both personal behavior and bodily manifestations. Often clients complain of dizziness and fantasies of sudden falls, which are completely groundless side effects of hypercontrol. When listening to such complaints, I remember Friedrich Nietzsche’s expression “That which is ready to fall, shall ye also push!”, so an experiment in which the therapist invites the client to stand up and tries to push him, can provide reliance on his own body, and prove illusory and groundless nature of his fear, and most importantly – this will provide confidence in one’s body.
Due to the fact that panic attacks are often happening during the transition from “oikos” to “polis”, from home to the big world, the main task is to return the supports to the inside. For this purpose the body creates energy, which is restrained, excitement for life, which finds no way out and is accumulated in the body. And because during such transition, the body, which finds no psychological supports, is perceived as an alien object, e.g. as “polis”, not “oikos”, so the excitement begins to “tear” a person from the inside with increased heartbeat and other terrifying symptoms. A lot of energy is accumulated inside, which finds no way out, there is no spontaneous creative output, and therefore it becomes destructive, even aggressive, because it should be directed at humanizing the world around (“polis”), which is of Dionysian origin (a positive aggressive force able to transform the world). This is why there are fears of losing control of oneself and losing one’s mind, and sometimes even fear of harming most loved ones.
In ancient Greek mythology, there is a god who represents the natural forces. His name is Pan (from Ancient Greek πάς) and it means, “every”, but there is also an Indo-European etymology of this name – “to make fertile”, so we can trace two complementary meanings. The first appeals to the story of Pan’s birth. He was the son of Hermes and the nymph Driope. Born with beard, horns, and goat legs, he immediately started jumping and laughing, but his mother got frightened and left the child, so then Hermes took him to Olympus. When they saw Pan, all the gods rejoiced in him. He grew up in the mountains and forests, and as a deity of fertility and wildlife, he was full of passion and love, and also loved wine and fun, arranging carefree noisy round dance, which frightened mortals.
The most interesting for us property of Pan is the ability to inspire people with a very strong fear, even horror, which is called in honor of the name of this god – panic. In modern society, panic attacks are a frequent disorder that gives people suffering from this symptom a lot of anxiety and limitations to function normally. Of course, at first glance it seems that talking about a panic attack as an honor of divine manifestations may seem at least strange, but I am deeply convinced, thanks to my personal experience of having panic attacks, as well as practical cases of psychotherapeutic work with clients, that given the full potential behind this symptomatology, with the right approach of a psychotherapist, panic attacks can be considered as a huge resource for growth and development in the self-realization of the human personality. Both as a spiritual being – ability to accept and be aware of the spontaneous, irrational, manifestations of your body, which in Gestalt therapy we equate to the manifestations of the “id” function, i.e., excitement which arises as if it were spontaneous and calls for the availability of certain incipient needs, which are those fertile functions for us, whose patron, according to legend, was the god Pan. And also as social beings – bringing joy to the world due to the ability to have fun, laugh, play and dance, i.e. to enjoy the acknowledgement of one’s wild nature, unknown and irrational, as well as the spontaneity of the manifestations within, which is the symbol of the Pan’s embodiement, manifested in a combination of his animal and human origin).
And if we recall a classical concept of art that originated in Classical antiquity and is embodied in the principle of mimesis, a dance for the gods, as not only imitation, but also as connecting of both the animal origin (natural, vivid, finite) with the divine (perfect, dead, stable, infinite) in art, then the notion of boundaries becomes obvious to us. And the human life is the art of existing on that boundary, similar to Pan, who turns the excitement into fertility, spontaneity into game, fun, and the emerging light at sunrise, but who also sends panic and fear to those who violate the laws by refusing to connect the finite with the infinite, and in the terminology of Gestalt therapy – figure and background.